Kostmann syndrome (KS) is named after Rolf Kostmann, who reported a condition he described as infantile agranulocytosis in 1956 and it was later termed as KS [1]. The ailment that Kostmann described is autosomal recessive. Since then, it has been discovered that KS is a genetically heterogeneous set of disease conditions, and thus the more commonly used term is severe congenital neutropenia (SCN). Modes of inheritance include autosomal dominant, autosomal recessive, X-linked, and a number of cases are sporadic. It is a rare disorder that affects both males and females in equal proportions.

Gene mutations include the gene encoding neutrophil elastase (ELA2) (the most frequent cause of SCN), colony stimulating factor 3 receptor (CSF3R) gene, and the HS1-associated protein X1 (HAX1) gene (responsible for autosomal recessive KS) [2] [3]. The same genes can be affected by different mutations, hence the varying presentation and treatment outcomes [4].

Affected individuals suffer from a wide range of opportunistic infections at a young age, ranging from minor infections to fatal illness. Examples include gingivitis, otitis media, upper respiratory tract infections, liver abscesses, various skin infections, omphalitis, and fever. Many of these infections are bacterial, although other organisms have been identified, such as fungi. The most common bacteria cultured are the Streptococcus and Staphylococcus species.

Congenital neutropenias represent a group of disorders, usually characterized by a low neutrophil count. Other features may be present, to varying degrees, depending on the genetic origin of the illness. SCN often involves failure of neutrophils to reach maturation in the bone marrow as well [5] [6]. The autosomal recessive form of KS is characterized by a more marked neutropenia than the other variants [7]. KS may be present as a part of another disorder, such as Fanconi pancytopenic syndrome or Chediak-Higashi syndrome.

A long-term complication of KS is the higher incidence of myelodysplastic syndrome (MDS) and leukemia (acute myeloid leukemia in particular), among those affected [5] [8]. The prognosis is often poor. Furthermore, the mutation in the HAX1 gene is associated with neurological impairment, manifesting as epilepsy, as well as cognitive and developmental delay [9].

• Recurrent Bacterial Infection

  Kostmann syndrome is a rare, severe, congenital neutropenia disorder characterized by a lack of mature neutrophils (absolute neutrophil counts less than 500 cells/mm3) associated with frequent, recurrent bacterial infections (e.g. otitis media, pneumonia [ebi.ac.uk]

  bacterial infections (e.g. otitis media, pneumonia, sinusitis, urinary tract infections, abscesses of skin and/or liver) and increased promyelocytes in the bone marrow. [orpha.net]

  Abstract Kostmann syndrome (KS) is an autosomal recessive disorder characterized by a low neutrophil count and recurrent bacterial infections, including periodontal disease. [ncbi.nlm.nih.gov]

  bacterial infections from early infancy. [semanticscholar.org]

• Refractory Anemia

  Anemia (RA) ✓ Refractory Anemia with Ringed Sideroblasts (RARS) ✓ Refractory Anemia with Excess Blasts (RAEB) ✓ Refractory Anemia with Excess Blasts in Transformation (RAEB-T) ✓ Chronic Myelomonocytic Leukemia (CMML) ✓ Lymphomas ( 80,000 Diagnoses Each [cryo-cell.com]

  We describe the clinical course of a patient who experienced refractory pure red cell aplasia (PRCA) after undergoing HLA-matched allogeneic peripheral blood stem cell transplantation (allo-PBSCT) for refractory anemia with an excess of blasts in transformation [ncbi.nlm.nih.gov]

  Granulocyte colony-stimulating factor inhibits Fas-triggered apoptosis in bone marrow cells isolated from patients with refractory anemia with ringed sideroblasts. [bloodjournal.org]

• Muscular Atrophy

  Spinal and Bulbar Muscular Atrophy Albert La Spada. Initial Posting: February 26, 1999; Last Update: January 26, 2017. Spinal Muscular Atrophy Thomas W Prior and Erika Finanger. Initial Posting: February 24, 2000; Last Update: December 22, 2016. [ncbi.nlm.nih.gov]

• Chorea

  Chorea-Acanthocytosis Antonio Velayos Baeza, Carol Dobson-Stone, Luca Rampoldi, Benedikt Bader, Ruth H Walker, Adrian Danek, and Anthony P Monaco. Initial Posting: June 14, 2002; Last Revision: April 18, 2019. [ncbi.nlm.nih.gov]

• Encephalopathy

  STXBP1 Encephalopathy with Epilepsy Yannay Khaikin and Saadet Mercimek-Mahmutoglu. Initial Posting: December 1, 2016. [ncbi.nlm.nih.gov]

The diagnosis of Kostmann syndrome is made when blood results drawn from successive differential counts, reveal an absolute neutrophil count (ANC) below 500 cells per microliter. Bone marrow analysis showing numerous immature promyelocytes also supports the diagnosis [5] [6] [10]. Furthermore, the bone marrow biopsy may show decreased cellularity and is important in ruling out possible malignancies [11]. Autosomal recessive KS, as described by Kostmann, has a neutrophil count less than 200 cells per microliter [7] [12].

Other features that might be present in the full blood count are anemia, in addition to elevated levels of platelets, monocytes, and eosinophils. The total white cell count remains within the average range, while the immunoglobulin G (IgG) is high. Other chemical parameters are usually normal, and patients respond normally to vaccinations. However, antinuclear antibodies (ANA) may be high if the underlying cause is autoimmune.

Genetic testing may also be conducted, in order to delineate the specific genetic mutation. Imaging modalities are sometimes used, and these include:

• X-rays,
• Dual-energy X-ray absorptiometry (DEXA) scanning. This is done to determine bone density, as patients with KS may have osteoporosis.

• Neutropenia

  Michael Gibson, M.S., M.D. [1] Synonyms and keywords: Severe congenital neutropenia, SCN Overview Kostmann syndrome is a rare inherited form of Severe Chronic Neutropenia usually detected soon after birth. [wikidoc.org]

  Kinsey, Robert Davis, Debra Scarlata, Beate Schwinzer, Cornelia Zeidler and Karl Welte, Severe chronic neutropenia: Treatment and follow-up of patients in the Severe Chronic Neutropenia International Registry, American Journal of Hematology, 72, 2, (82 [doi.org]

  This rare blood disorder is characterized by severe chronic neutropenia. Symptoms associated with severe chronic neutropenia include recurring fevers, mouth ulcers, and periodontitis. [accessanesthesiology.mhmedical.com]

  See also Neutropenia Granulocyte colony-stimulating factor Support Groups: Severe Chronic Neutropenia International Registry Neutropenia.ca [bionity.com]

  Congenital neutropenia is due to diverse causes. Not all patients with congenital neutropenia have mutations in the GCSFR gene. [rxlist.com]

The results of the study indicate that nonsurgical treatment of Kostmann syndrome periodontitis can reduce supragingival and salivary herpes viral loads. [ncbi.nlm.nih.gov]

Apoptosis was significantly diminished in sections obtained during treatment with G-CSF. [ashpublications.org]

Without special treatment, patients died before 2-3 years. [m.iliveok.com]

If the bone marrow is not irreparably damaged, the prognosis is good with proper treatment, and the patient will recover as the production of granulocytes resumes. [medical-dictionary.thefreedictionary.com]

The prognosis is often poor. Furthermore, the mutation in the HAX1 gene is associated with neurological impairment, manifesting as epilepsy, as well as cognitive and developmental delay. [symptoma.com]

Niemeyer, Prevalence, clinical characteristics, and prognosis of GATA2-related myelodysplastic syndromes in children and adolescents, Blood, 127, 11, (1387), (2016). Kanwaldeep Mallhi, David B. Dix, Karen Y. [doi.org]

The finding of the disease associated variants in this thesis will eventually contribute to improved diagnosis, prognosis, risk assessment and a future treatment of patients. [diva-portal.org]

Prognosis With the advent of G-CSF therapy infectious deaths are rare. Approximately 10% of patients develop AML. This is associated in almost all cases with G-CSF-R mutations. [atlasgeneticsoncology.org]

Neutropenia is very common in preterm infants, and certainly very few of these will have Kostmann syndrome as the etiology. [nature.com]

It has multiple genetic etiologies, the earliest described being autosomal recessive. Patients present with severe infections early in life. [symptoma.com]

The neutropenia was ascribed to bacterial infection and no other etiologic explanations were sought. [pediatrics.aappublications.org]

In 40% of patients, a genetic etiology for severe congenital neutropenia was unknown. [11] Mortality/Morbidity The mortality rate is 70% within the first year of life in the absence of medical intervention with granulocyte colony-stimulating factor (G-CSF [emedicine.com]

Frequency International Epidemiological data are limited given the overlapping case definitions of congenital neutropenia and few patient registries. [emedicine.com]

Zeidan, Epidemiology of acute myeloid leukemia: Recent progress and enduring challenges, Blood Reviews, 10.1016/j.blre.2019.04.005, (2019). [doi.org]

Pathophysiology: though the underlying genetic defect in myeloid precursor cells is not entirely elucidated, mutations in the gene (ELA2) encoding neutrophil elastase appear to be present in most patients. [bionity.com]

[…] include: Homeostasis and migration of neutrophil granulocytes,Granulocyte-colony Stimulating Factor (G-CSF) receptor signaling,New Granulocyte-colony Stimulating Factor (G-CSF) Receptor Signaling Pathways ,Neutrophil elastase (ELANE) – Genetics and Pathophysiology [books.google.com]

The purpose of this project was to improve the understanding of the clinical course and the pathophysiology of autosomal recessive SCN. [openarchive.ki.se]

She has an active role in Public Education to minimize and control inherited blood diseases, environmental pollution and cancer prevention. Email: [email protected] [longdom.org]

Comprehensive and up-to-date, Hematopoietic Growth Factors in Oncology: Basic Science and Clinical Practice offers an integrated survey of the role of HGFs in treating and preventing anemia, neutropenia, and thrombocytopenia in patients with malignant [books.google.com]

If it achieves funding, they will provide "adequate remuneration for the provision of data and samples and invite you for co-authorship of any subsequent research publications." 11 JAN 2015 Science Patient compliance rates for SIT therapy to prevent peri-implantitis [efp.org]

She has an active role in Public Education to minimize and control inherited blood diseases, environmental pollution and cancer prevention. Email: [email protected] PDF HTML [omicsonline.org]

Tea tree oil : Tea tree oil is purported to have antiseptic properties, and has been used traditionally to prevent and treat infections. [livingnaturally.com]

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